Idiopathic or immune thrombocytopenic purpura, also known as primary thrombocytopenic purpura (ITP for short), is a relatively common type of bleeding disorder. It is currently considered to be an immune-related disorder. It can be divided into acute type and chronic type. The acute form is most often seen in children and has a similar incidence in men and women. The chronic form is more common and is more common in young women. The acute form has heavy clinical bleeding. However, it is often self-limiting, or with active treatment, it often gradually recovers or heals within a few weeks. A small number of patients can be delayed for about six months, and there are also those who develop into chronic. Chronic bleeding symptoms are generally mild, but are prone to recurrent attacks, each of which often lasts for several weeks or months. After treatment, the patient may be cured or in remission, and the duration of remission varies, and can be several months or years.
Clinical manifestations: acute type.
1, purpura may have a history of upper respiratory tract infection or viral infection before appearing.
2, the onset of the disease is rapid, often with fever, skin petechiae petechiae, and even large hematomas. Bleeding from the nose, gums and oral mucosa is common.
3.Seriously, there may be internal bleeding, such as gastrointestinal tract, urinary tract and genital tract, and even intracranial bleeding.
4. Platelets are mostly below 20×10 to the ninth power/L.
Chronic type.
1, slow onset, with long-term subcutaneous bleeding, gingival and oral mucosa bleeding, women often with excessive menstruation as the main manifestation.
2. About 10% of recurrent cases are associated with mild splenomegaly.
3, moderate decrease in platelets 30-80×10 of 9 times / L.
Diagnosis based on.
1, Decreased platelet count on multiple laboratory tests.
2.The spleen is not enlarged or only mildly enlarged.
3, Increased or normal megakaryocyte count on bone marrow examination with maturation disorders.
4.Any of the following 5 points should be present.
(1) Glucocorticoid therapy is effective.
(2)Spleen excision is effective.
(3) Increased PAIg.
(4) PAC3 is increased.
(5) Shortened platelet lifespan.
(5) Exclude secondary thrombocytopenia.
Medication principles.
1, light cases with “A” basic drugs mainly.
2, medium and heavy cases and combined with iron deficiency to “A” basic drugs, can be added “B” optional drugs and splenectomy.
Indications for splenectomy.
(1) Those who have failed to respond to corticosteroid and immunosuppressive therapy for more than 6 months;
(2) Contraindication to the application of corticosteroids;
(3) Those who have intracranial hemorrhage and have failed to receive active medical treatment can be considered for splenectomy.